Navegando por Palavras-chave "Fixação de fratura"
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- ItemAcesso aberto (Open Access)Análise tomográfica do espaço interalveolar e da espessura da cortical óssea vestibular na região parassinfisária de mandíbulas humanas adultas(Universidade Federal de São Paulo (UNIFESP), 2009-01-28) Uzêda, Sandra de Quadros [UNIFESP]; Alonso, Luis Garcia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To assess the thickness of the mandibular bone in the interalveolar space corresponding to the dental units 3.3; 3.4; 3.5; 4.3; 4.4, 4.5, in the mental foramen region and the thickness of the bone cortical in the same region and to analyze the viability of fixating Champy miniplates (System 2.0®) with monocortical screws in the direction of the interalveolar space of the units 3.3, 3.4, 3.5, 4.3, 4.4, 4.5. Methods: Fifty dry mandibles of dentate adults (25 females and 25 males) aging from 33 to 87 years were used. These catalogued mandibles were acquired from the Human Anatomy Laboratory from the University of State of Bahia, state of Bahia, Brazil. Mandibles with malformations or macroscopic pathological changes in the body of the mandible were excluded. Initially we identified a point (P) located 1.25mm above the upper margin of the mental foramen of the mandible (right side: P´ and left side: P”). This distance corresponds to half of the width of the bridge of the titanium miniplate, System 2.0® that is generally used above the mental foramen in the Champy technique, whose objective is to eliminate tension zones when treating mandibular fractures. After identifying the (P) point, the mandible was placed over an acrylic base horizontally with a vertical rod, planned and constructed to identify the points A´, B´, C´ and A”, B” and C” which correspond to the units 4.3; 4.4; 4.5 and 3.3; 3.4; 3.5. After marking the points, the interalveolar distances were measured by indirect analysis using axial computed tomography (CT) cuts. After delimiting and perforating the points, these were filled with previously heated gutta-percha that served as a marker in the CT cuts. Five (05) mandibles of the sample were cut in a way as to allow direct biometry with the objective of comparing and validating the CT measurements. Results: The data show that the thickness of the vestibular cortical bone is not enough to adequately implant and fixate the screws even though the interalveolar distance is sufficiently safe to introduce them. The data point towards a deficiency in the bone support required to generate the procedures of the Champy technique since the anatomy of the mandible does not present elements that support placing the plates and screws in the way recommended by the technique. There is no adequate bone support to promote the necessary stability.
- ItemSomente MetadadadosAvaliação da eficiência de fresas cirúrgicas em relação a geração de calor, tempo de fresagem e geometria de corte(Universidade Federal de São Paulo (UNIFESP), 2006) Saad, Paulo Abdalla [UNIFESP]; Faloppa, Flavio [UNIFESP]INTRODUÇÃO: A manipulação do tecido ósseo é praticada por diversas especialidades médicas e odontológicas. Princípios biológicos e técnicos devem ser pesquisados continuamente, gerando procedimentos cada vez mais seguros e previsíveis. A temperatura gerada nas perfurações tem sido destacada por diversos autores como de fundamental importância na preservação do tecido ósseo. MÉTODOS: Avaliação da temperatura e tempo gasto na fresagem utilizando fresas de 2,0mm em mandíbula de suínos e submeter os valores encontrados à avaliação estatística. A morfologia superficial e geometria de corte das fresas foram avaliadas antes e depois do uso. RESULTADOS: O tempo gasto para realizar a perfuração de 10mm foi crescente após o sexto ciclo de uso. A temperatura gerada foi crescente com o uso. A temperatura excedeu o limite seguro de 43ºC após 18 perfurações. Houve correlação estatisticamente significativa entre a elevação da temperatura e o tempo gasto na fresagem. As avaliações das medidas das fresas não demonstraram variações significativas. A morfologia das fresas revelou desgaste dos ângulos de corte que podem ter contribuído para o aumento da temperatura. CONCLUSÃO: A temperatura gerada pela fresagem foi correlacionada com o tempo gasto na perfuração, apesar de apresentar desgaste no ângulo de corte, as fresas não demonstraram alterações dimensionais na sua estrutura. As fresas do Sistema Conexão de Próteses devem ser substituídas após 18 ciclos de uso..
- ItemAcesso aberto (Open Access)Intervenções para o tratamento de fratura e pseudartrose da clavícula em adultos e adolescentes: revisão sistemática(Universidade Federal de São Paulo (UNIFESP), 2010-11-25) Lenza, Mário [UNIFESP]; Faloppa, Flávio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: To evaluate the effectiveness of different methods of treatment for acute fracture or non-union of the middle third of the clavicle in adults and adolescents. Methods: Search strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, trial registries and reference lists of articles. No language or publication restrictions were applied. Selection criteria: Randomised and quasi-randomised controlled trials evaluating any intervention for treating fractures or non-union of the middle third of the clavicle were considered. The primary outcomes were pain, treatment failure and health-related quality of life or shoulder function. Data collection and analysis: Two authors independently selected eligible trials and three authors assessed methodological quality and cross-checked data extraction. Results: Conservative interventions: Three trials were included in this comparison. Two trials compared the figure-of-eight bandage with sling in a total of 234 participants. Both trials were underpowered and compromised by poor methodology. One trial found slightly higher pain levels in the bandage group at 15 days, and the other trial reported greater discomfort during bandage wear. There were no significant differences in functional or other outcomes reported for either trial. The third trial, which evaluated therapeutic ultrasound in 120 participants, was also underpowered but had a low risk of bias. The trial found no statistically significant difference between low-intensity pulsed ultrasound and placebo in the time to clinical fracture healing or in any of the other reported outcomes. Surgical versus conservative interventions: Four studies, two with moderate and two with high risk of bias were included. Two compared plate fixation versus sling; plate fixation showed better patient-based upper extremity outcome scores and less treatment failure. Other two trials comparing intramedullary fixation versus conservative interventions presented better upper limb function to the surgery treatment. Surgical interventions: Data from four small trials, each testing a different comparison, were included. Three trials had design features that carry a high risk of bias, limiting the strength of their findings. Low-contact dynamic compression plates appeared to be associated with significantly better upper-limb function throughout the year following surgery, earlier fracture union and return to work, and a reduced incidence of implant-associated symptoms when compared with a standard dynamic compression plate in 36 adults with symptomatic non-union of the middle third of the clavicle. One study (69 participants) compared the Knowles pin versus plate for treating middle third clavicle fractures or non-union. Knowles pins appeared to be associated with lower pain levels and use of post-operative analgesics, reduced incidence of implant-associated symptoms, and shorter operation time and hospital stay. One study (133 participants) found that a three-dimensional technique for fixation with a reconstruction plate was associated with a significantly lower incidence of symptomatic delayed union than a standard superior position surgical approach. One study (201 participants) assessed the intramedullary fixation for treating acute clavicle fractures comparing closed and opened reduction; there were statistical significant differences in favour of closed reduction with percutaneous fixation for the primary outcomes. Conclusion: There is limited evidence, from single trials only, regarding the effectiveness of different methods for treating fracture and non-union of the middle third of the clavicle. Further research is warranted.
- ItemAcesso aberto (Open Access)Osteossínteses com hastes intramedulares em crianças(Sociedade Brasileira de Ortopedia e Traumatologia, 2009-10-01) Fernandes, Helio Jorge Alvachian [UNIFESP]; Saad, Eduardo Abdalla [UNIFESP]; Reis, Fernando Baldy dos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The authors present a comprehensive review of the literature emphasizing the use of flexible intramedullary nails in the treatment of fractures in children, focusing the treatment of femoral shaft and forearm fractures and emphasizing the importance of the non-surgical approach. Children's age and weight threshold are not well defined for the use of the method. The removal of implants is a controversial matter in the literature, with a trend towards keeping the implants.
- ItemAcesso aberto (Open Access)Visualização radiológica intraoperatória da região occipitocervical e coluna cervical superior: nota técnica(Sociedade Brasileira de Coluna, 2009-06-01) Mudo, Marcelo Luis [UNIFESP]; Amantéa, Andrea Vieira [UNIFESP]; Cavalheiro, Sergio [UNIFESP]; Joaquim, Andrei Fernandes; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)We report a technical note to obtain a better intraoperative radiological view in surgeries of the craniocervical junction and upper cervical spine.